Living Will

This Living Will form directs your healthcare providers to withdraw life-sustaining treatment if you are unable to make informed medical decisions and are in a terminal condition or permanently unconscious state. You can end your living will at any time—simply tell your doctors and family that you revoke your living will. Ask to have all copies of the living will returned to you and destroy them.

If you do not choose to limit any or all forms of life sustaining treatment, do not use this form. You have a legal right to choose that and document those wishes. You may want to hire an attorney to draft that document for you.

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After You Finish

Learn what to do when you have finished filling out this form.
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After you download and fill out this form, follow these steps:

  • Carefully read and review the form. If you leave any sections blank, write “None” in that space or cross out the entire section.
  • Sign the form. You must either sign the form in front of two witness who fill out the witness statement on page 7, or sign the form in front of a notary public.
  •  Make copies. After the form is signed, make several photocopies.
  • Share copies of the form. Give a copy of the form to your healthcare power of attorney agent if you have one, your doctor and the hospital you are likely to be admitted to. Anytime you go to the hospital, bring a copy of the form with you.
  • Talk with your loved ones. It is helpful to share that you have a living will with your loved ones. That way, in case of an emergency, they can follow your wishes.